Of sex and science. Elizabeth Pisani's blog about HIV and other sundry things.

15/02/08

I’m aware that my ambivalent attitude towards tracing the sex partners of HIV-infected people in order to offer them testing, prevention services and treatment if necessary is unpopular in some quarters. When I look at what the Egyptian government is up to, I can really see why.

According to Human Rights Watch and Amnesty International, Egypt has just added another four men to the roll of those arrested because they are suspected of being gay and having HIV. That brings the total since last October to 12.

According to the report, it started like this:
“…police intervened between two men having an argument on a street in central Cairo. When one of them told the officers that he was HIV-positive, police immediately took them both to the Morality Police office and opened an investigation against them for homosexual conduct. Police demanded the names of their friends and sexual contacts during interrogations….
Police then arrested two more men because their photographs or telephone numbers were found on the first two detainees. Authorities subjected all four men to HIV tests without their consent. All four are still in detention, pending prosecutors’ decisions on whether to bring charges of homosexual conduct. The first two arrestees, who reportedly tested HIV-positive, are still being held in hospital, handcuffed to their beds…. In November 2007, police raided an apartment where one of these men had previously lived, and arrested four more men. All were charged with homosexual conduct.”

This is exactly the kind of vicious absurdity that opponents of routine testing and contact tracing fear. But the fact that it happens in Egypt does not necessarily mean it will happen elsewhere. We need to support people whose rights are being abused in this way, but that does not necessarily mean that we cannot, in less vicious countries, apply basic principles of infectious disease control to HIV.

While we’re on the subject of absurd and vicious responses to homosexuality, check out what Dubai is up to. Raiding all those hair salons for dangerous gays. Tut tut. As a commentator on Towleroad said, it’s not looking great for gay men in Moslem countries right now. I hope readers in Indonesia will set him straight. Or not.

As a health scientist I’m sure you’ve already looked at the literature and found that contact tracing for chronic sexually transmitted diseases has not been proven to be of benefit. And as a person living in Indonesia where the epidemic is blood borne you already know that there are no studies of contact tracing for infections caused by using nonsterile injecting equipment. Why are you ambivalent? Where’s your evidence?

It is in part *because* the evidence is not strong (in either direction) that I am ambivalent. But in terms of being able to identify people who may be unaware that they are in need of treatment, and of course in terms of identifying people who are most in need of prevention services, it seems like a sensible step to take. I think the issue remains unresolved. How would you feel if you found out that a doctor knew that you were at direct risk of HIV infection because your regular sex partner was infected, but they had done nothing to alert you to this fact? It’s a genuinely tough one.